| T. R. Davis D.c. Inc. | |
|
1805 Park Ave W Ontario OH 44906-2229 | |
| (419) 529-6600 | |
| (419) 529-4677 |
| Full Name | T. R. Davis D.c. Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1805 Park Ave W, Ontario, Ohio |
| Authorized Official Name and Position | Timothy Roger Davis (PRESIDENT) |
| Authorized Official Contact | 4195296600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| T. R. Davis D.c. Inc. 1805 Park Ave W Ontario OH 44906-2229 Ph: (419) 529-6600 | T. R. Davis D.c. Inc. 1805 Park Ave W Ontario OH 44906-2229 Ph: (419) 529-6600 |
| NPI Number | 1073890034 |
|---|---|
| Provider Enumeration Date | 11/04/2011 |
| Last Update Date | 11/04/2011 |
| Medicare PECOS PAC ID | 8224205893 |
|---|---|
| Medicare Enrollment ID | O20120123000401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073890034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 712 (Ohio) | Primary |
| Provider Name | Timothy R Davis |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1477629319 PECOS PAC ID: 0941477517 Enrollment ID: I20120123000418 |
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